| NPI | 1568432730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA OPT6250T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT6250TPA) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA OPT6250TPA) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2008-12-23 |